Provider Demographics
NPI:1962597724
Name:BEITELSCHEES, TED ALLEN
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:ALLEN
Last Name:BEITELSCHEES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 HAZELTON DR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-2368
Mailing Address - Country:US
Mailing Address - Phone:419-693-3760
Mailing Address - Fax:
Practice Address - Street 1:3100 W. CENTRAL AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2919
Practice Address - Country:US
Practice Address - Phone:419-578-4110
Practice Address - Fax:419-578-4100
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0701057Medicaid